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General NPI Number Information
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NPI Number | 1912850579
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Entity Type | Individual
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Provider Name | ELISSA ROOP
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Gender | Female
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 133 SPINDER DR
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City | EAST PEORIA
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State | IL
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Zip | 61611-0016
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Country | US
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Telephone | 855-673-4325
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Fax | 855-673-4325
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Provider Business Mailing Address
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Address Line | 133 SPINDER DR
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City | EAST PEORIA
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State | IL
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Zip | 61611-0016
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Country | US
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Telephone | 855-673-4325
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Fax | 855-673-4325
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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